MANAGEMENT OF PORTAL VEIN THROMBOSIS IN PATIENTS WITH CIRRHOSIS IN THE LIVER TRANSPLANTATION

Objective To investigate the treatment and outcome of Liver transplantation(LT) for liver cirrhosis with portal vein thrombosis(PVT).Methods 161 patients who underwent LT between October 2005 and March 2007 were analyzed retrospectively.To compare the incidence of PVT,the method to deal with PVT and the outcome of the patients.Results 15 cases of 161 patients were diagnosed PVT,including 8 of grade 1,4 of grade 2,3 of grade 3.The incidence of PVT with splenectomy was higher(45.5% vs 6.7%,P0.05).There were 6 patients of grade 1,4 patients of grade 2 who had undergone embolectomy in the LT.Among the patients of grade 3,there was 1 patient who had underwent embolectomy and 2 patients who had used the donor iliac vessel to act as a bridge between the donor portal vein and the host superior mesenteric vein.Among the 3 grade of PVT,the mean operation time was 77.5±0.7 h,8.7±1.7 h,11.8±2.3 h and RBC transfusion during operation was 5.4±2.3 U,7.8±1.3 U,13.7±1.5 U,respectively.Compared with grade 3 of PVT,the mean operation time and RBC transfusion of grade 1 and 2 were less(P0.05).There were no significant differences in perioperative survival(86.6% vs 90.4%,P0.05),or 1-year survival(80% vs 82.2%,P0.05).Conclusions Patients suffering from end stage liver disease with PVT can obtain good results by applying reasonable methods.The management is more difficult in patients with PVT of grade 3.Splenectomy should be avoided before LT.